Prevention of stroke in patients with chronic coronary syndromes or peripheral arterial disease
Por:
Parker, WAE, Gorog, DA, Geisler, T, Vilahur, G, Sibbing, D, Rocca, B, Storey, RF
Publicada:
1 nov 2020
Resumen:
Stroke is a common and devastating condition caused by atherothrombosis, thromboembolism, or haemorrhage. Patients with chronic coronary syndromes (CCS) or peripheral artery disease (PAD) are at increased risk of stroke because of shared pathophysiological mechanisms and risk-factor profiles. A range of pharmacological and non-pharmacological strategies can help to reduce stroke risk in these groups. Antithrombotic therapy reduces the risk of major adverse cardiovascular events, including ischaemic stroke, but increases the incidence of haemorrhagic stroke. Nevertheless, the net clinical benefits mean antithrombotic therapy is recommended in those with CCS or symptomatic PAD. Whilst single antiplatelet therapy is recommended as chronic treatment, dual antiplatelet therapy should be considered for those with CCS with prior myocardial infarction at high ischaemic but low bleeding risk. Similarly, dual antithrombotic therapy with aspirin and very-low-dose rivaroxaban is an alternative in CCS, as well as in symptomatic PAD. Full-dose anticoagulation should always be considered in those with CCS/PAD and atrial fibrillation. Unless ischaemic risk is particularly high, antiplatelet therapy should not generally be added to full-dose anticoagulation. Optimization of blood pressure, low-density lipoprotein levels, glycaemic control, and lifestyle characteristics may also reduce stroke risk. Overall, a multifaceted approach is essential to best prevent stroke in patients with CCS/PAD.
Filiaciones:
Parker, WAE:
Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Cardiovasc Res Unit, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England
Gorog, DA:
Imperial Coll, Natl Heart & Lung Inst, Dept Med, London, England
Univ Hertfordshire, Postgrad Med Sch, Hatfield, Herts, England
Geisler, T:
Univ Tubingen, Dept Cardiol & Angiol, Tubingen, Germany
Vilahur, G:
IIB St Pau, Cardiovasc ICCC Program, Hosp Santa Creu & St Pau, Res Inst, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Cardiovasc CIBERCV, Madrid, Spain
Sibbing, D:
Privatklin Lauterbacher Muhle Ostersee, Munich, Germany
Ludwig Maximilians Univ Munchen, Munich, Germany
Med Klin & Poliklin 1, Campus Grohadern, Munich, Germany
Rocca, B:
Catholic Univ, Dept Pharmacol, Sch Med, Rome, Italy
Storey, RF:
Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Cardiovasc Res Unit, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England
Green Published, hybrid
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